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Tuesday, January 30, 2007

Smoking a pack a day would cost you about $2 555 over one year. Deposit this money into a retirement savings plan and over 20 years you would have over $104 743 (assuming a 7% rate of return and $7 per 20 cig. pack)

Source: I got this tidbit from a "Smoke Free Ontario" flyer from the Government of Ontario and the Canadian Cancer Society. I don't have the exact scientific citation, but I did get the flyer approximately around January 30th.

Saturday, January 27, 2007

Health Canada and the Canadian Dental Association have both sent out alerts regarding Benzocaine topical anaesthetic sprays and and Methemoglobinemia (MHb). Here's the quote from the CDA alert (dated November 28th):

Benzocaine sprays are one of the choices for topical anesthesia in dentistry. Used in excessive doses, it can lead to MHb, a potentially serious blood condition that can result in an impaired ability of red blood cells to bind and carry oxygen and may lead to cyanosis, weakness and coma. Benzocaine sprays have been cited in several U.S. reports as a cause of MHb, generally involving the use of large amounts of benzocaine spray in patients undergoing endoscopy. One case of MHb was reported in an oral surgery patient with a large facial abscess requiring a fibreoptic intubation with the use of benzocaine topical spray. MHb has also been associated with excessive doses of the local anesthetic prilocaine.

Health Canada has received 9 reports of suspected MHb associated with the use of benzocaine to date, none of which have been fatal. Almost all reported cases were associated with higher concentration benzocaine spray products (14-20%) used in the mouth and on other mucous membranes. Sprays containing 20% benzocaine, as well as topical gels or ointments containing 20% benzocaine in a soluble base, are available for use in dental offices in Canada.

After reviewing Health Canada’s notice, Drs. Haas and Sándor provided customized recommendations for dentists, to help minimize the likelihood of benzocaine-induced MHb.Benzocaine topical anesthetic should be avoided in dental patients who are susceptible to MHb, such as those with either congenital or acquired MHb or any disorder that reduces the oxygen-carrying capacity of blood.

Alternatives to benzocaine sprays, such as topical lidocaine preparations, are available and should be used for patients with an MHb risk factor.

Mucosal damage or inflammation at the application site may result in an increased systemic uptake of benzocaine. Therefore topical anesthetic must be applied very judiciously.

Use the minimum quantity of spray needed to achieve the desired effect.

The cyanosis associated with MHb is not responsive to oxygen, although its administration should not be withheld. The presence of chocolate brown coloured blood is another sign of MHb. Patients may also develop other signs and symptoms of MHb such as pallor, nausea, muscle weakness, dizziness, confusion, agitation, dyspnea and tachycardia.

Patients with suspected cases of MHb should be sent immediately to a hospital emergency department for management, accompanied with appropriate information that MHb is suspected. This will help guide treatment, which includes the administration of 1-2 mg/kg methylene blue intravenously.

Sunday, January 21, 2007

In the "not a surprise" department, a study in the Journal of the American Dietetic Association (October 2006) said that the most commonly purchased drinks from vending machines were soft drinks and other sugar-sweetened drinks.

The researchers also discovered that children who eat at fast food restaurants were more likely to consume these drinks.

Sunday, January 14, 2007

I just finished reading the latest issue of AGD Impact magazine (Jan 2007) and they had a few news stories that I'd like to share with you over the next week or so. First off: gum disease and premature babies.

The latest study in the Nov 2nd issue of the New England Journal of Medicine found that the treatment of periodontitis in pregnant women did not prevent preterm births. 13% of the control group gave birth early, while 12% of the treatment group did...a statistically irrelevant difference. These latest findings contradict the previous research on the topic.

I guess we will have to wait for more studies to definitively give us the answer on this topic.

Dental floss, especially newer brands, is shred-resistant, and when strands end up in waste-water, they bind with other waste, creating what one Toronto Water supervisor called a "snowball effect." Clumps are formed – one found last week was about the size of a softball – and they gum up impellers, which are part of the pumps in the city's sanitary pumping stations. Strands of floss wrap around the motors of the impellers – rotating devices that move the waste. When the motors don't have enough power to overcome the jam, they shut down.

I have to admit that I used to flush my floss, but I've now changed that practice. My new advice to patients and my own philosophy is: floss every day and throw it in the appropriate garbage system.

Friday, January 05, 2007

I believe in the future, a significant portion of dentistry will be done by laser. The advantages are numerous: less discomfort, better tissue response and none of the typical drill sounds. However, the cost is pretty prohibitive as the moment ($85 000-$100 000 for each machine multiplied by the number of operatories in a particular practice...ouch). Wider adoption of the technology is sure to happen when the price drops significantly (say about $25 000 per machine).

CNN had an article this morning on the topic and how incentives are being used to stimulate sales of these lasers. Here are some teaser quotes from the article:

Some dentists are resistant to change, while others just have bad memories about the older laser drills. Older models were less popular with dentists because they were difficult to use and therefore not as safe as the new laser-water drills.

"There is a number of dentists who have a dated concept of what laser dentistry is, and that gives Biolase a challenge of reaching these dentists, [to teach them] how far advanced Biolase really is," said Biolase chief executive Jeffrey Jones. Biolase is wooing dentists with the promise that its HydroPhotonics technology causes no pain and therefore requires no anesthetic.

Also, to drum up business for its $85,000 Waterlase drill, Biolase and its distributor, Sullivan-Schein Dental, offered a holiday sales promotion that included a $5,000 discount plus a 50-inch plasma TV and a $5,000 Sullivan-Schein merchandise gift certificate.

How about improving the manufacturing process and reducing the price? :)

If you make it in, it's a minimum 4 years more of schooling to become a general practitioner (in certain US states, you may need a further year of residency). Specialist training requires many additional years of training.

Monday, January 01, 2007

There is more calculus (hard buildup) on the lingual (inside) of lower anterior teeth as compared to other teeth for a few reasons. In general, an acidic pH is bad for buildup. Sugar actually slows down the buildup process due to an acidic pH. So this particular area of the mouth has:

Faster clearance: these areas are cleaned better (think tongue etc.) so sugars are not in the area too long which results in more buildup

Faster saliva film velocity (I) : again clearing sugars quickly

Faster saliva film velocity (II): also results in more urea being transported to the area, which help in the neutralization of acids...which helps create calculus

Whew! That was a bit technical, but I hope it provides some insight. :)